泛自閉症障礙學前孩童行為及情緒問題之危險因子

Abstract

泛自閉症障礙者是具有行為及情緒問題的高風險群，這些行為及情緒問題可能對他們在學習及社交關係上造成負面的影響，並且會進一步地干擾介入的成效及長期預後。本研究目的為探討泛自閉症障礙學前孩童行為及情緒問之危險因子。受試者來自大台北地區的發展中心、綜合醫院的復健部、兒童心智科門診及日間病房，共有53位三至五歲的泛自閉症障礙孩童參與本研究。我們將檢視孩童的性別、年齡、自閉症症狀嚴重度、適應性行為、認知功能、表達性語言，以及與家長相關的危險因子，如親職壓力和家長心理健康狀態等，與孩童的行為及情緒問題間之相關性。家長根據孩童的行為及情緒問題填寫兒童行為調查問卷/1.5-5歲(Child Behavior Checklist 1.5-5)。並以多元線性迴歸模式(Multiple linear regression models)來探討泛自閉症障礙學前孩童行為及情緒問題的重要預測因子。結果顯示親職壓力及家長心理健康狀態與孩童的外化問題呈顯著正相關，而孩童的出生順序(Birth order)和是否接受職能治療與其外化問題呈顯著負相關；親職壓力及家長心理健康狀態與孩童的內化問題呈顯著正相關，而孩童的出生順序與其內化問題呈顯著負相關。研究發現認為泛自閉症障礙學前孩童的行為及情緒問題與家長的社會心理狀態(psychosocial status)間為雙向影響，而這也凸顯了我們必須教導家長應對策略(coping strategies)或提供社會支持來協助他們的社會心理調適(psychosocial adjustment)及壓力紓解之重要性。

Individuals with autism spectrum disorders (ASD) are at high risk for behavioral and emotional problems which may lead to huge negative impacts on their learning, and social relationships, and further interfering with intervention efforts and the long-term prognosis. The aim of this study was to identify risk factors for the behavioral and emotional problems in preschool children with ASD from both the perspectives of subject characteristics and of en-vironmental factors. Fifty three children with ASD aged from 3 to 5 years were recruited from developmental centers, pediatric rehabilitation clinics and child psychiatric department in general hospitals in the Greater Taipei area. The relationship between behavioral/emotional problems and the following variables was examined: child gender, child age, socioeconomic status, severity of autistic symptoms, adaptive behaviors, cognitive functioning, expressive language and parent-related risk factors, including parenting stress and mental health. Parents rated their child’s behavioral and emotional problems using the Child Behavior Checklist 1.5-5 (CBCL1.5-5). Multiple linear regression models were fitted to identify the important predictors of behavioral and emotional problems as measured by the CBCL1.5-5 in children with ASD. Results of multiple linear regression analyses showed that parenting stress and pa-rental mental health were associated with higher scores on externalizing problems, whereas birth order and receiving occupational therapy service were associated with lower scores on externalizing problems; parenting stress and parental mental health were associated with higher scores on internalizing problems whereas younger birth order was associated with lower scores on internalizing problems. Findings suggest that the impact of behavioral and emotional problems in preschool children with ASD on parental psychosocial status may be viewed as bidirectional which highlights the need to teach coping strategies or provide social supports to parents of preschool children with ASD to help with their psychosocial adjustment and stress relief.